1. Birthweight Variations, Gestational Age & Preterm/Postterm Care

what is the sequence of initial newborn interventions?

1. dry and warm

2. suction mouth, then nose if needed

3. assess breathing

4. assess oxygen saturation

5. assess heart rate

what birthweight percentile is appropriate for gestational age?

10th–90th percentile

what birthweight percentile is small for gestational age?

below the 10th percentile

what birthweight percentile is large for gestational age?

above the 90th percentile

what is low birthweight?

below 2,500 g

what is very low birthweight?

below 1,500 g

what is extremely low birthweight?

below 1,000 g

what commonly causes a newborn to be small for gestational age?

inadequate placental oxygen and nutrient delivery

what maternal factors increase the risk of a large-for-gestational-age newborn?

• diabetes

• obesity

• previous macrosomic infant

• multiparity

• post-term

what complications should the nurse monitor for in a small-for-gestational-age newborn?

• hypoglycemia

• hypothermia

• polycythemia

what should the nurse assess for in a large-for-gestational-age newborn?

• birth injuries

• hypoglycemia (including recurrent episodes)

what gestational age is preterm? *

20 weeks through 37 weeks 6 days

what gestational age is term? *

38–41 weeks

what gestational age is postterm?

born after 42 weeks gestation

what physical findings suggest postmaturity?

• dry, cracked, peeling skin

• little or no vernix or lanugo

• long nails

• wasted extremities

• decreased subcutaneous fat

what complications are postterm newborns at risk for?

hypoxia from decreased placental function;hypoglycemia;hypothermia;meconium aspiration

how should nursing care be organized for a preterm newborn? *

cluster care to conserve energy;keep stimulation low

how can the nurse prevent cold stress in a preterm newborn?

warmer or Isolette;warm environment;skin-to-skin care when stable

when should the mother be transferred if delivery at a hospital with a NICU is needed?

before birth when safe;helps prevent mother–baby separation

what is bronchopulmonary dysplasia?

chronic lung injury from oxygen toxicity, barotrauma, and inflammation

how can respiratory support limit lung injury in a preterm newborn?

gentle, noninvasive ventilation when possible;lowest effective oxygen concentration

why are preterm newborns prone to apnea and bradycardia?

immature respiratory control center

why can preterm newborns have difficulty feeding orally?

immature suck–swallow–breathe coordination

how may nutrition be provided when a preterm newborn cannot feed adequately by mouth?

feeding tube;TPN and lipids;small amounts of breast milk or colostrum introduced early when appropriate